Provider Demographics
NPI:1538157631
Name:EVANS, STACY N (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:N
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 BRENDA LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1241
Mailing Address - Country:US
Mailing Address - Phone:229-439-7396
Mailing Address - Fax:
Practice Address - Street 1:1110 N MONROE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1949
Practice Address - Country:US
Practice Address - Phone:229-888-8121
Practice Address - Fax:229-888-6374
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051934208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics